Provider Demographics
NPI:1790925022
Name:MILLER, DAVID SEWALL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SEWALL
Last Name:MILLER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 154
Mailing Address - Street 2:
Mailing Address - City:SCOTTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14546-0154
Mailing Address - Country:US
Mailing Address - Phone:585-889-7065
Mailing Address - Fax:
Practice Address - Street 1:25 ROCHESTER ST
Practice Address - Street 2:
Practice Address - City:SCOTTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14546-1333
Practice Address - Country:US
Practice Address - Phone:585-889-7065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103625207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY103625OtherNEW YORK STATE LICENSE NUMBER